Skin Tumors — MCQs
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Which of the following nevus types is most commonly associated with malignant melanoma development?
Actinic keratoses are associated with
Which of the following nevi has the highest risk of malignant transformation to melanoma?
Which of the following conditions is associated with tuberous sclerosis?
Skin Tumors Indian Medical PG Practice Questions and MCQs
Question 281: Which of the following nevus types is most commonly associated with malignant melanoma development?
- A. Junctional nevus
- B. Intradermal nevus
- C. Blue nevus
- D. Dysplastic nevus (Correct Answer)
Explanation: ***Dysplastic nevus*** (Correct) - **Dysplastic nevi** are considered precursor lesions and markers for increased risk of developing **malignant melanoma**. - Individuals with multiple dysplastic nevi have a significantly higher lifetime risk of melanoma compared to the general population. - Also known as **atypical nevi**, they show architectural disorder and cytologic atypia on histology. *Junctional nevus* (Incorrect) - **Junctional nevi** are benign moles with melanocytes located at the **dermo-epidermal junction**. - While theoretically a melanoma can arise from any nevus, junctional nevi are less frequently associated with melanoma development than dysplastic nevi. *Intradermal nevus* (Incorrect) - **Intradermal nevi** are benign moles where the melanocytes are located entirely within the **dermis**. - These nevi are generally stable, often appearing flesh-colored or light brown, and have a very low potential for malignant transformation. *Blue nevus* (Incorrect) - **Blue nevi** are benign lesions characterized by **deeply situated dermal melanocytes** that produce a blue or blue-black color due to the Tyndall effect. - They are typically stable and have a very low risk of malignant transformation; however, rarely, an atypical blue nevus or cellular blue nevus can undergo malignant change.
Question 282: Actinic keratoses are associated with
- A. Keratoacanthoma
- B. Basal cell carcinoma (BCC)
- C. Squamous cell carcinoma (SCC) (Correct Answer)
- D. Malignant melanoma
Explanation: ***Squamous cell carcinoma (SCC)*** - **Actinic keratoses** are considered a **premalignant lesion** and are the most common precursor to invasive cutaneous SCC. - They represent **atypical keratinocytes** that have the potential to progress to SCC, particularly with continued sun exposure. *Basal cell carcinoma (BCC)* - While BCC is also a **sun-related skin cancer**, it typically develops de novo and is **not directly associated** with actinic keratoses as a precursor. - BCC usually arises from the **basal layer of the epidermis** or hair follicles, unlike SCC which originates from keratinocytes. *Malignant melanoma* - **Melanoma** originates from **melanocytes**, not keratinocytes, and is not associated with actinic keratoses. - Its precursors include **dysplastic nevi** or de novo development, distinct from the epidermal changes seen in actinic keratosis. *Keratoacanthoma* - **Keratoacanthoma** is a rapidly growing, dome-shaped tumor that can resemble SCC, and some consider it a **low-grade SCC variant**. - While it may share some features with SCC, actinic keratoses are more broadly recognized as precursors directly to typical invasive SCC rather than specifically to keratoacanthoma.
Question 283: Which of the following nevi has the highest risk of malignant transformation to melanoma?
- A. Congenital nevus (Correct Answer)
- B. Dermal nevus
- C. Junctional nevus
- D. Lentigo nevus
Explanation: ***Junctional nevus*** - Junctional nevi are located at the **epidermal-dermal junction** and have a higher potential for **malignant transformation into melanoma** compared to other types of nevi [1,2]. - They often present as flat, pigmented lesions, making them distinguishable and more likely to undergo **dysplastic changes** associated with melanoma [1,4]. *Dermal nevus* - Dermal nevi are located deeper in the **dermis** and have a **lower risk** of transformation into melanoma [2]. - They are usually dome-shaped and lack the architectural changes that indicate a potential for malignancy [3]. *Lentigo nevus* - Lentigo nevi are generally benign pigmented lesions that result from **increased melanocyte activity** and are not typically associated with melanoma. - Although they can appear in sun-exposed areas, their risk for malignant transformation remains **minimal**. *Congenital nevus* - Congenital nevi can vary in size and may have some potential for **melanoma transformation**, but this risk is generally lower than that for junctional nevi. - Larger congenital nevi have a higher risk, yet they do not specifically relate to **common malignant transformation** compared to junctional nevi. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1146-1150. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 649-650. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 648-649.
Question 284: Which of the following conditions is associated with tuberous sclerosis?
- A. leprosy
- B. tuberculosis
- C. bone disorders
- D. angiofibromas (Correct Answer)
Explanation: ***Vascular fibroma*** - Vascular fibromas are one of the lesions associated with **tuberous sclerosis**, reflecting the hamartomatous nature of this condition [1]. - Tuberous sclerosis commonly causes **angiofibromas** (facial lesions) and other tumors, showing the vascular component in its pathology [1]. *tuberculosis* - Tuberculosis is an infectious disease caused by **Mycobacterium tuberculosis**, unrelated to tuberous sclerosis. - Key features include pulmonary symptoms and systemic manifestations, differing significantly from the **hamartomas** seen in tuberous sclerosis [1]. *leprosy* - Leprosy is caused by **Mycobacterium leprae** and affects the skin and peripheral nerves, with no connection to the genetic condition of tuberous sclerosis. - Clinical signs include **hypopigmented skin lesions** and **nerve damage**, which do not overlap with the **tumors** seen in tuberous sclerosis [1]. *bone disorders* - While bone disorders can occur in various conditions, they are not specifically associated with tuberous sclerosis. - Tuberous sclerosis primarily involves **neurological** and **cutaneous** manifestations rather than directly affecting bone integrity [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.
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Premalignant Epidermal Tumors
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